No Degree - Nha
Triton College
08.2018 - 05.2019
Maximina (Maxine) Hernandez
Medical Reimbursement Specialist
Westchester,IL
Timeline
MEDICARE REIMBURSEMENT SPECIALIST
Byram Healthcare Centers., Inc
06.2016 - 03.2024
Patient Account Representative
DuPage Medical Group Midwest Physicians
07.2014 - 03.2016
Billing and Collections Specialist
Elmhurst Memorial Healthcare Elmhurst Clinic
03.2012 - 07.2014
Refunds Representative
Elmhurst Memorial Healthcare Elmhurst Clinic
01.2009 - 02.2012
Proviso East High School
09.1985 - 06.1989
Work History
MEDICARE REIMBURSEMENT SPECIALIST
Byram Healthcare Centers., Inc
Downers Grove, IL
06.2016 - 03.2024
- Request and review of medical records for the purpose of submitting first, second and third level Medicare appeals and follow-up of the same.
- Identify and submit billing corrections via the clearing house.
- Researched and reported payer trends to management.
Assisted in special projects as assigned for different payers. - Researched rejections, investigating problems to appeal claims.
Patient Account Representative
DuPage Medical Group Midwest Physicians
Downers Grove, IL
07.2014 - 03.2016
- Properly and effectively review, monitor and follow-up on all outstanding medical insurance balances including filing of appeals on a timely manner for Commercial, Managed Care, Liability and Government payers.
- Monitoring of incoming monies from insurance carriers for the purpose of identifying necessary money transfers between accounts and/or refunding insurance over-payments.
- Daily communication with the Customer Service Representatives on patient complaints when it refers to patient balance disputes to resolve the complaint promptly and thus maximize patient satisfaction.
- Work closely and in constant communication with clinical and Coding personnel to reduce billing errors.
Billing and Collections Specialist
Elmhurst Memorial Healthcare Elmhurst Clinic
Elmhurst, IL
03.2012 - 07.2014
- Accurate and timely 'scrubbing' and filing of Commercial, Managed Care and State of IL claims.
- Work closely and in constant communication with clinical and Coding personnel to reduce billing errors.
Submit commercial, managed care and governmental claim appeals within the timely filing periods to ensure maximum reimbursements. - Identify and prepare refund requests for patients as well as insurance payers.
- Maintain constant communication with patients regarding verification of insurance, patient demographic information and collection of outstanding patient balances.
- Apply internal and external adjustments, moving of insurance / customer monies whenever applicable to correct and close any discrepancies
Refunds Representative
Elmhurst Memorial Healthcare Elmhurst Clinic
Elmhurst, IL
01.2009 - 02.2012
- Analyze and research patient and insurance credits.
Manually populate information on check format using QuickBooks, print checks, prepare for mailing, and electronically transmit file to the bank. - Maintain effective communication with the Accounting Department when it refers to voided checks, stop payments, unable to find forwarding mailing address and refund reports.
- File appeals and contact insurance companies on recoupments for the purpose of collecting outstanding balances on accounts.
- Back-up to the Cash Management Department.
Overview
15
15
years of professional experience
4
4
years of post-secondary education
Education
Proviso East High School
Maywood, IL 09.1985 - 06.1989
No Degree - Nha
Triton College
River Grove, IL 08.2018 - 05.2019
Skills
- Healthcare Terminology
- Medical appeals
- Claim Processing
- Microsoft Office
- Eligibility Verification
- Collections
- Policy Evaluation
- Reading Comprehension
- Diagnostic Codes
Summary
Experienced Reimbursement Specialist with 15 years of experience. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive.
Certification
National Healthcareer Association